Healthcare Provider Details

I. General information

NPI: 1588479380
Provider Name (Legal Business Name): AVA ELIZABETH LOVELACE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 HWY 45 BYPASS
JACKSON TN
38305
US

IV. Provider business mailing address

2863 HWY 45 BYPASS
JACKSON TN
38305
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0305
  • Fax: 731-506-1839
Mailing address:
  • Phone: 731-422-0305
  • Fax: 731-506-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number38147
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: